Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

Background/Aims: We evaluated the feasibility and long-term efficacy of the combination of cytarabine, idarubicin, and all-trans retinoic acid (ATRA) for treating patients with newly diagnosed acute promyelocytic leukemia (APL). Methods: We included 87 patients with newly diagnosed acute myeloid leukemia and a t(15;17) or promyelocytic leukemia/retinoic acid receptor alpha (PML-RARα) mutation. Patients received 12 mg/m2/day idarubicin intravenously for 3 days and 100 mg/m2/day cytarabine for 7 days, plus 45 mg/m2/day ATRA. Clinical outcomes included complete remission (CR), relapse-free survival (RFS), overall survival (OS), and the secondary malignancy incidence during a 20-year follow-up. Results: The CR, 10-year RFS, and 10-year OS rates were 89.7%, 94.1%, and 73.8%, respectively, for all patients. The 10-year OS rate was 100% for patients that achieved CR. Subjects were classified according to the white blood cell (WBC) count in peripheral blood at diagnosis (low-risk, WBC < 10,000/mm3; high-risk, WBC ≥ 10,000/mm3). The low-risk group had significantly higher RFS and OS rates than the high-risk group, but the outcomes were not superior to the current standard treatment (arsenic trioxide plus ATRA). Toxicities were similar to those observed with anthracycline plus ATRA, and higher than those observed with arsenic trioxide plus ATRA. The secondary malignancy incidence after APL treatment was 2.7%, among the 75 patients that achieved CR, and 5.0% among the 40 patients that survived more than 5 years after the APL diagnosis. Conclusions Adding cytarabine to anthracycline plus ATRA was not inferior to anthracycline plus ATRA alone, but it was not comparable to arsenic trioxide plus ATRA. The probability of secondary malignancy was low.

Purpose: To confirm that the phaco chop method using an illuminated chopper (iChopper; Oculight, Seongnam, Korea) can reduce cataract surgery complications, and that even beginners can safely and effectively perform phaco chop. Methods: We retrospectively analyzed the medical records of the first 30 phaco chop cases using illuminated chopper of four cataract surgeons. Four ophthalmologists had a variety of empirical backgrounds, from those who have experienced more than 10,000 cataract surgery, to beginners who have experienced 20 cataract surgery. Results: Of the total 120 eyes, two eyes (1.67%) had posterior capsule rupture. The chopping method was changed from phaco chop to stop and chop in three eyes (2.5%) including one eye with brown cataract with pseudoexofoliation syndrome and two eyes with nuclear opacity grade ≥5. Conclusions The rates of posterior capsule rupture of phaco chop using an illuminated chopper were very low in four surgeons with various experiences and who became proficient shortly in phaco chop.

Background and Objectives: The study sought to investigate the impact of early extracorporeal membrane oxygenation (ECMO) support before revascularization in patients with acute myocardial infarction (AMI) complicated by profound cardiogenic shock after resuscitated cardiac arrest. It is difficult to determine optimal timing of ECMO in patients with AMI complicated by profound cardiogenic shock after resuscitated cardiac arrest. Methods: Among 116,374 patients experiencing out-of-hospital cardiac arrest in South Korea, a total of 184 resuscitated patients with AMI complicated by profound cardiogenic shock, and who were treated successfully with percutaneous coronary intervention (PCI) and ECMO, were enrolled. Patients were divided into 2 groups according to the timing of ECMO: pre-PCI ECMO (n=117) and post-PCI ECMO (n=67). We compared 30-day mortality between the 2 groups. Results: In-hospital mortality was 78.8% in the entire study population and significantly lower in the pre-PCI ECMO group (73.5% vs. 88.1%, p=0.020). Thirty-day mortality was also lower in the pre-PCI ECMO group compared to the post-PCI ECMO group (74.4% vs.91.0%; adjusted hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.47–0.93; p=0.017). Shockable rhythm at the emergency room (HR, 0.57; 95% CI, 0.36–0.91; p=0.019) and successful therapeutic hypothermia (HR, 0.40; 95% CI, 0.23–0.69; p=0.001) were also associated with improved 30-day survival. Conclusions ECMO support before revascularization was associated with an improved short-term survival rate compared to ECMO after revascularization in patients with AMI complicated by profound cardiogenic shock after resuscitated cardiac arrest.

Background and Objectives: The study sought to investigate the impact of early extracorporeal membrane oxygenation (ECMO) support before revascularization in patients with acute myocardial infarction (AMI) complicated by profound cardiogenic shock after resuscitated cardiac arrest. It is difficult to determine optimal timing of ECMO in patients with AMI complicated by profound cardiogenic shock after resuscitated cardiac arrest. Methods: Among 116,374 patients experiencing out-of-hospital cardiac arrest in South Korea, a total of 184 resuscitated patients with AMI complicated by profound cardiogenic shock, and who were treated successfully with percutaneous coronary intervention (PCI) and ECMO, were enrolled. Patients were divided into 2 groups according to the timing of ECMO: pre-PCI ECMO (n=117) and post-PCI ECMO (n=67). We compared 30-day mortality between the 2 groups. Results: In-hospital mortality was 78.8% in the entire study population and significantly lower in the pre-PCI ECMO group (73.5% vs. 88.1%, p=0.020). Thirty-day mortality was also lower in the pre-PCI ECMO group compared to the post-PCI ECMO group (74.4% vs.91.0%; adjusted hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.47–0.93; p=0.017). Shockable rhythm at the emergency room (HR, 0.57; 95% CI, 0.36–0.91; p=0.019) and successful therapeutic hypothermia (HR, 0.40; 95% CI, 0.23–0.69; p=0.001) were also associated with improved 30-day survival. Conclusions ECMO support before revascularization was associated with an improved short-term survival rate compared to ECMO after revascularization in patients with AMI complicated by profound cardiogenic shock after resuscitated cardiac arrest.

BACKGROUND: To investigate the influence of nocturnal ambient light on visual function and ocular fatigue. METHODS: Sixty healthy subjects (30 men and 30 women) aged 19 through 29 years with no history of ocular disease were recruited. All subjects spent 3 consecutive nights in the sleep laboratory. During the first and second nights, the subjects were not exposed to light during sleep, but during the third night, they were exposed to ambient light, measuring 5 or 10 lux at the eye level, which was randomly allocated with 30 subjects each. The visual function and ocular fatigue were assessed at 7 a.m. on the 3rd and 4th mornings, using best-corrected visual acuity, refractive error, conjunctival hyperemia, tear break-up time, maximal blinking interval, ocular surface temperature, and subjective symptoms reported on a questionnaire. RESULTS: Three men and three women subjects failed to complete the study (4 in the 5 lux; 2 from the 10 lux). For the entire 54 subjects, tear break-up time and maximal blinking interval decreased (P = 0.015; 0.010, respectively), and nasal and temporal conjunctival hyperemia increased significantly after sleep under any ambient light (P < 0.001; 0.021, respectively). Eye tiredness and soreness also increased (P = 0.004; 0.024, respectively). After sleep under 5 lux light, only nasal conjunctival hyperemia increased significantly (P = 0.008). After sleep under 10 lux light, nasal and temporal conjunctival hyperemia, eye tiredness, soreness, difficulty in focusing, and ocular discomfort increased significantly (P < 0.05). CONCLUSION: Nocturnal ambient light exposure increases ocular fatigue. Avoiding ambient light during sleep could be recommended to prevent ocular fatigue.
Asthenopia ; Blinking ; Dry Eye Syndromes ; Fatigue* ; Female ; Healthy Volunteers ; Humans ; Hyperemia ; Lighting ; Male ; Refractive Errors ; Tears ; Visual Acuity

Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, altered mental function, seizures, and loss of vision predominantly affecting the bilateral parieto-occipital area. Most cases of PRES are associated with hypertension, or use of immunosuppressants or cytotoxic drugs; associated brainstem and cerebellar lesions are uncommon. We report herein a case of PRES that developed in a patient after injecting a steroid for cervical pain management. The presence of a territorial lesion along the vertebral artery on the same side as the pain-management procedure suggests an association between injectable steroid suspension and PRES.
Brain Stem ; Headache ; Humans ; Hypertension ; Immunosuppressive Agents ; Neck Pain ; Pain Management ; Posterior Leukoencephalopathy Syndrome* ; Seizures ; Steroids ; Vertebral Artery ; Zygapophyseal Joint*

No abstract available.
Ataxia* ; Immunoglobulin G* ; Ophthalmoplegia*

PURPOSE: The aim of study was to determine the cut-off value of serum parathyroid hormone levels with a predictive value for the occurrence of clinical hypocalcemia following total thyroidectomy. METHODS: We performed a retrospective review, of 150 patients who underwent total thyroidectomy for papillary thyroid carcinoma from January 2010 to July 2010. We measured the serum levels of parathyroid hormone and phosphate within 18~24 hours postoperatively. The serum levels of ionized calcium were measured immediately and within 18~24 hours postoperatively. We also determined the cut-off value, sensitivity and specificity of serum levels of parathyroid hormone, ionized calcium, and phosphate with a predictive value for the occurrence of clinical hypocalcemia. RESULTS: Serum levels of parathyroid hormone were 2.0±1.7 pg/ml in the clinical hypocalcemia group, 9.9±10.7 pg/ml in the asymptomatic hypocalcemia group, and 15.3±10.7 pg/ml in the normal control group (P<0.001). Serum levels of ionized calcium were also significantly lower in the clinical hypocalcemia group (0.92±0.16 mmol/L) compared with the normal control group (P=0.002). On the other hand, serum levels of phosphate were significantly higher in the clinical hypocalcemia group (P=0.009). The cut-off value of serum parathyroid hormone levels for the prediction of clinical hypocalcemia was 4.5 pg/ml, where the sensitivity, specificity, positive predictive value, and negative predictive value were 87.5%, 63.4%, 89.3% and 59%, respectively. CONCLUSION: Serum parathyroid hormone levels following total thyroidectomy are the most powerful predictive factors for the occurrence of clinical hypocalcemia. Our results show that the incidence of clinical hypocalcemia is relatively higher at postoperative serum levels of parathyroid hormone ≤4.5 pg/ml.
Calcium ; Hand ; Humans ; Hypocalcemia* ; Incidence ; Parathyroid Hormone* ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Neoplasms ; Thyroidectomy*